Sugar-Sweetened Beverages Associated With Increased Gastric Cancer Risk, With Andrew Chan, MD, MPH

Sugar-sweetened beverages, including carbonated beverages, punch, lemonade, and sports drinks, may be linked to gastric cancer incidence, according to new findings from a 2-decade prospective cohort study of 112,284 participants, published in Gastro Hep Advances.

In those with consumption of > 1 sugar-sweetened beverage in a day, the incidence of gastric cancer was higher compared to those who never partake (Hazard Ratio [HR], 2.45; 95% Confidence Interval [CI], 1.49 – 4.04), and was similar among both sexes.

“We were able to show that consumption of sugar-sweetened beverages was associated with a higher risk of developing gastric cancer,” senior author Andrew Chan, MD, MPH, chief of the Clinical and Translational Epidemiology Unit at Massachusetts General Hospital, told HCPLive in an interview, “which speaks to the possibility of a relationship between metabolic dysfunction and risk of this cancer — something that hasn't been well characterized in the past.”

Why Investigate Sugar-Sweetened Beverages and Gastric Cancer Risk?

Gastric cancer is the 4th leading cause of cancer death worldwide, and while overall rates have been decreasing for decades, cases are increasing among adults under 50, particularly women, with younger patients also presenting with more advanced disease at diagnosis. The single biggest risk factor for stomach cancer is infection with Helicobacter pylori (H. pylori), though several dietary exposures have also been associated with gastric cancer risk.

Chan and colleagues investigated whether sugar-sweetened or artificially sweetened beverages, the latter defined as low-calorie carbonated beverages, were associated with gastric cancer incidence. They drew on data from the Nurses' Health Study (NHS), which enrolled 121,700 female registered nurses aged 30-55, and the Health Professionals Follow-up Study (HPFS), which enrolled 51,529 male health care professionals aged 40-75.

A Prospective Look at Diet and Gastric Cancer Risk

Dietary intake, including beverage consumption, was assessed using validated food frequency questionnaires collected every 4 years, which Chan explained allowed the team to evaluate diet before cancer developed, offering more confidence in a potential causal relationship.

“That's different from retrospective studies, where people who already have cancer are more likely to misremember their diet, or more likely to recall the 'bad stuff' they ate rather than reflecting accurately,” Chan explained. “The prospective nature of the study gives us some ability to infer cause and effect and understand whether there's a potential association.”

Investigators identified 278 cases of gastric cancer over more than 3.2 million person-years of follow-up, using Cox proportional hazards models adjusted for factors including diet, body mass index, smoking, alcohol use, and diabetes.

Artificially Sweetened Beverages Show No Gastric Cancer Link

There was no association between artificially sweetened beverage intake and gastric cancer incidence.

“That makes us think this potential link could be through metabolic dysfunction, through pathways we know sugar-sweetened beverages may operate through — like raising blood insulin and glucose levels,” Chan explained. “Some of these insulin pathways that link to risk of gastrointestinal cancer may be a particular reason for why we saw this association.”

H. Pylori, Fructose, and Sugar-Sweetened Beverage Intake

Sugar-sweetened and artificially sweetened beverage intake were not associated with H. pylori infection in either cohort, suggesting the elevated cancer risk associated with sugar-sweetened beverages is unlikely to be driven by H. pylori infection status.

A positive association between total fructose intake, the primary sweetener in sugar-sweetened beverages, and gastric cancer incidence was observed in the total cohort and among women.

Counseling Patients on Gastric Cancer Risk Factors

“There are also concerning signals that the incidence of gastric cancer may be increasing in younger people in particular,” Chan said. “It's possible that the associations we found in this study speak to the possibility that we're seeing more stomach cancer in younger generations because of increases in metabolic disease in younger populations.”

Chan connected this trend to broader shifts in metabolic health over recent decades.

“We know overweight, obesity, and other metabolically related diseases have been increasing for the last several decades, and whether that pattern links with risk of gastric cancer has been unknown,” he said. “Our data does suggest there could be a potential link.”

Targeting Metabolic Pathways for Gastric Cancer Prevention

To Chan and colleagues’ knowledge, this is the first study to demonstrate an association between sugar-sweetened beverage intake and gastric cancer incidence.

The connection can exist through several possible mechanisms, including weight gain, insulin resistance, hormone imbalance, inflammation, and dysbiosis. However, the precise carcinogenic pathway has yet to be established, and future studies are needed to confirm these findings.

“If we understand that overweight and obesity pathways are linked to stomach cancer,” Chan noted, “that could open further studies into how we might target these mechanisms for either preventive or therapeutic interventions.”

Editor’s Note: Chan reports relevant disclosures with Pfizer Inc., Boehringer Ingelheim, and Freenome Holdings.

References

1. Gweon TG, Ha J, Kim H, Du M, Song M, Chan AT. Association between sugar-sweetened and artificially sweetened beverage intake and gastric cancer incidence. Gastro Hep Advances. Published online 2026. doi:10.1016/j.gastha.2026.101097

2. Thrift AP, Wenker TN, El-Serag HB. Global burden of gastric cancer: epidemiological trends, risk factors, screening and prevention. Nat Rev Clin Oncol. 2023;20(5):338-349. doi:10.1038/s41571-023-00747-0